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• • <br />.M '« y« <br />1. What is Person 6's name? Print name below. <br />Last Name =~~~• <br />First Name MI <br />2. How is this person related to Person 11 Mark ©ONE box. <br />^ Husbandlwife If NOT RELATED to Person 1: <br />^ Natural-bom soNdaughter ^ Roomer, bgarder <br />,~ ^ Adopted son/daughter <br />F ^ Housemate, roommate <br />^ Stepsonlstepdaughier ^ Unmarried partner <br />r ^ Brother/sister ^ Foster child <br />? ^ Father/mother <br />^ Other nonrelative <br />^ Grandchild `'~ <br />t ^P~rent-in-law ,~=- <br />1 O Sonin-lawfdaughter-in-law : i ~~ `~•~ <br />,~ <br />^ Other relative -Print <br />{ exact relationship. --~ __ <br />3. What is this person's sex? MarkQ~ONE box. <br />,, <br />^ Male ^ Female ~'~=%` v <br />4. What is this person's age:.-atrd:~wliat is this person's date <br />i of birth? `~2rin>;numbers in boxes. <br />..~_ <br />Age on April 1, 2000 ' i'd~nth Day Year of birth <br />r , <br />,:__ . <br />~J <br />~-~ NOTE: Pieas~e-answer BOTH Questions 5 and 6. <br />„ ., , <br />/l ~>~~ ~: <br />5. Is this-p"arson Spanish/Hispanic/Latino? Mark ~ the <br />"Ma"tiox` if not Spanish/Hispanic/Latino. <br />' ^ IYo, not Spanish/Hispanic/Latino ^ Yes, Puerto Rican <br />i <br />i ^ Yes, Mexican, Mexican Am., Chicano <br />^ Yes, Cuban <br />^ Yes, other Spanish/Hispanic/Latino -Print group. ~ <br />i <br />a <br />i <br />6. What is this person's race? Mark ©one or more races to <br />indicate what this person considers himself/herself to be. <br />s ^ White <br />^ Black, Afripn Am., or Negro <br />} ^ American Indian or Alaska Native - Print name of enrolled or principal tribe. ~ <br />^ Asian Indian ^ Japanese ^ Native Hawaiian <br />^ Chinese ^ Korean ^ Guamanian or Chamorro <br />^ Filipino ^ Vetnamese ^ Samoan <br />^ Other Asian - Print race. ~ ^ Other Pacific Islander -Pant race. ~ <br />^ Some other race - Pani race. ~ <br />~ If more people live here, list their names on the <br />back of this page in the spaces provided. <br />Please turn <br />to go to last <br />page. <br />Form U81A <br /> <br />